Proposed VA Nursing Rule Riles Anesthesiologists

The American Society of Anesthesiologists (ASA) slammed a draft of a new Veterans Health Administration (VHA) nursing handbook that calls for advance practice nurse anesthetists within the system to attain independent status and function without the support, oversight, or supervision of a physician.

"This document effectively eliminates the gold standard, physician-led, team-based coordinated care in anesthesiology," said Jane C.K. Fitch, MD, of the University of Oklahoma in Oklahoma City, and president-elect of the ASA, in a teleconference.

"The VHA intends this to be the policy for all its hospitals, superseding state law, where currently more than half of states require physician supervision of nurse anesthetists," she said.

The document also would prohibit local facilities from having policies that contradict the federal policy. "So local chiefs of anesthesiology will no longer have the authority to set policies they deem best for the patients they serve," she said.

If the changes are implemented, advance practice nurses who choose not to pursue the training to attain independent status will no longer be permitted to work in a VHA facility.

She pointed out that patients in the VHA system are 15 times more likely to have poor health status than their peers, and 14 times more likely to have five or more medical conditions.

She also noted that she herself initially trained as a nurse and as a nurse anesthetist and then went on to receive a medical degree as an anesthesiologist.

"The length and depth of training are dramatically different. As physician anesthesiologists we trained for 12 to 14 years rather than 5 to 7. Nursing education and training did not prepare me for the level of care needed in the perioperative environment when seconds matter," she said.

The nursing handbook hasn't yet been published or made available for public review. If the policy change goes forward, full implementation would be required by a year after the document's publication.

ASA stated that it has been trying for 4 months to meet with the VHA and provide input, including a letter dated July 2 to the Office of the Under Secretary for Health.

"ASA strongly believes that the current team-based model of care is without question in the best interests of safe quality care, especially for vulnerable VHA patients," she concluded.

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